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Workers Compensation Issues

Evolving Health Technology Models

Mark Walls , Kimberly George | October 16, 2020

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Video conference call with a doctor

Technology is continuously changing the healthcare landscape. From reshaping ease of access to quality care to improving system efficiencies and interoperability, all aspects are reimagined. Telemedicine and digital health are disrupters that will continue to evolve on-demand solutions and care management significantly.

Three industry leaders from the Alliance of Women in Workers' Compensation joined us on our Out Front Ideas with Kimberly and Mark webinar to discuss the evolution of health care and its impact on workers compensation.

  • Artemis Emslie—CEO of Cadence Rx
  • Dr. Melissa Burke—vice president and head of managed care and clinical at AmTrust Financial Services, Inc.
  • Ann Schnure—vice president of telemedicine operations at Concentra

Health Care Reimagined

Access to care has become increasingly on-demand with advances in telemedicine and telehealth. Consumers want to engage with their health more than ever, and these tools put access in the palm of their hands. But from a claims perspective, are workers compensation professionals encouraging this kind of engagement from injured workers? Are employers encouraging use throughout their staff? It is essential to consider how impactful these tools can be in communicating with an injured worker and in creating healthy trends in the workforce.

Applying consumer data is integral to creating the best healthcare solutions since new healthcare models are personalized, predictive, and preventive. Health care has historically been viewed as sick care, but with health care becoming more holistic, it covers a range that also includes well care. This range of care has moved to a decentralized model that connects everyone, including payers, service providers, and healthcare providers. While this model provides an easier connection to meet the needs of users, it also makes systems more vulnerable. Since private health data is often the target of cyber attacks, this puts security at the forefront of technology advances.

Throughout all evolutions of health, it is essential to remember that health is human-centric. Technology applications should always be used for improving efficiency and accuracy, shifting how engaged consumers are with their health data.

Skills Competition

When developing solutions to advance the needs within the workers compensation industry, are you considering what skill gives your company a competitive edge? There is a considerable lack of engagement with digital health in workers compensation. Its real-time data could provide critical insights into medication adherence and postsurgery recoveries and opportunities for an injured worker to speak to a case manager or nurse. Using these digital health advances could alter the engagement for all parties involved in a claim and should be considered when developing a path for a return to work.

Using our most crucial skills also means leveraging partnerships to develop the best solutions possible. One speaker noted that partnerships occur across all stakeholders, including our patients, and how we are engaging them. Start with the patient journey and then move outwards to other stakeholders to keep your solution consumer-focused. Then proceed to use external resources, even engaging with your competitors, since not all solutions can be developed from within one resource.

The Investment Thesis

Investments in new health technologies should always focus on the ability to drive smart and connected devices, personalized health care, and digitalized guidance and provide 24/7 accessibility to experts. Investors lean toward these ideas since they typically make consumers more engaged with their health. Understanding patterns in consumer behaviors, investors are also aware that technology that links to increased employer-sponsored benefits drives funding and more-substantial deals. In 2019, 1 in 3 healthcare deals were within the digital space. Notably, women's health and behavioral health technology earned significant investments last year.

One of our guests spoke to the critical changes being driven by employers in health care, noting that venture capitals and angel funds are explicitly looking to invest in this field of evolution. Investors want to see a real impact on employees. Since blockchain technology protects user data, allowing the sharing of information in a trusted and safe environment, investors are also highly interested in this ever-expanding technology. Blockchain could be used to improve the patient/pharmacy experience and securely share data across a supply chain.

Payer Perspectives

In creating healthcare solutions, it is imperative to understand the perspective of a workers compensation payer and how they are incorporating healthcare technology into their business practices. One guest noted that the workers compensation industry should be incorporating technology and innovation into the foundation of our builds. We should be asking how we can do things differently from the beginning and bring a personalized approach to each injured employee. It is essential to balance these new technologies with human nature and match our resources with the right claim, using them to improve our processes.

Wearables, for example, can be used as a preventative measure and as a motivator. They can be used to stay connected and engaged with an injured employee and track progress. They can provide valuable data regarding who is most at risk in the workforce or who is taking the necessary steps to prevent injury. Providing experts access to this data maintains relevancy to our goals, allowing a more personalized and proactive approach to the care of an injured worker.

Mental health has also changed with telehealth and telemedicine, providing us with information on how it impacts a claim. Access to the most updated information on new drugs can provide critical data on drug interactions and reactions, allowing us to make the best decision for an injured employee and improving the outcome of a claim.

Telemedicine Disruptor

Before the pandemic, telemedicine was viewed as an additional benefit of employer-provided health care. Now, there is an urgency to work through all the regulatory issues and make it widely available. There is now a paradigm shift from patients not feeling comfortable with telemedicine to ask if it is an option, so they do not have to go into a doctor's office, putting themselves at risk. This increased demand is leading to the most dramatic shift in healthcare delivery history.

There are still many regulations on the delivery of care for an injured worker. Everyone in the industry should understand what is permissible in their jurisdictions in the workers compensation system to deliver appropriate care. For example, Washington, DC, regulations have shifted to allow telemedicine within a patient's home instead of within a medical facility. These changes are part of a group of emergency responses that expired on July 2, 2020, so industry professionals need to keep an eye on how these regulations shift.

There have also been significant interests in providing telerehab and behavioral health services. With federal, state, and workers compensation-level emergency regulations changing daily, we need to work with regulators to make sure these types of services are reimbursable. Additionally, some companies are offering examinations for quarantined employees, so they can be screened before returning to work, ensuring the safety of all other employees, especially those in the essential sector.

Will You Be the Disruptor or Disrupted?

As health and health care continue to be more consumer-centric, evaluate if your company is doing what it needs to create new solutions consistently or if it is becoming stagnant in a data-driven world. Is your model engaging injured workers to custom fit their needs? Consider retooling your solution to enhance the consumer experience if it does not have their interests in mind.

As workflow barriers continue to decrease, especially amid the pandemic crisis, it provides more room for growth in technology. Advances in virtual tools and assistance will increase as the need for a telehealth model only increases for at-risk individuals. Most significantly, postpandemic, expect to see increased requests for telemedicine technology and requested changes in workers compensation regulations.

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